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Efficacy and safety of limb position on blood loss and range of motion after total knee arthroplasty without tourniquet: A randomized clinical trial
Wu Y, Lu X, Ma Y, Zeng Y, Xiong H, Bao X, Shen B
International Journal of Surgery (London, England). 2018;60:182-187.
Abstract
BACKGROUND The purpose of this study was to investigate the effect of postoperative limb position on blood loss and knee function after primary total knee arthroplasty without tourniquet. MATERIAL AND METHODS One hundred patients were randomly assigned into 2 groups: Group A was given a knee flexion position at 60 degrees for 24h after surgery but without the tourniquet use. Patients in group B was received the tourniquet use the same flexion position as the Group A. All patients received intravenous (IV) tranexamic acid (TXA) 15mg/kg before skin incision and another 1g of IV-TXA after 3h. RESULTS The total blood loss was similar in the 2 groups. Group A had significantly less hidden blood loss and drainage volume (P=0.023, P<0.001), and higher intraoperative blood loss than the Group B (P<0.001). The visual analog scale and knee circumference in Group A were lower than the Group B on postoperative days 1, 3 and 5. The range of motion was also lowering in Group A than the Group B on postoperative days 1, 3, 5 and at the 1 month. No significant differences (P>0.05) were observed between the 2 groups regarding maximum hemoglobin drop, transfusion rate, postoperative hospital stay, DVT and/or PE, and wound-related complications. CONCLUSION Based on the current evidence, patients treated with postoperative limb positions without a tourniquet can effectively reduce hidden blood loss and drainage volume, as well as better early clinical benefits than those treated with a tourniquet. LEVEL OF EVIDENCE Therapeutic Level I.